Advent Care Systems of Ocilla, LLC
Organization Active NPI Rural Health Clinic/Center · Ocilla, GA
NPI 1982227781 · NPPES record last updated Sep 16, 2020
Key facts
- NPI
- 1982227781
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- ADVENT CARE SYSTEMS OF OCILLA, LLC
- Practice address
- 501 N Irwin Ave
Ocilla, GA 31774-5007 - Phone
- (912) 433-0615
- NPI assigned
- May 27, 2020
- Organization subpart
- No
Authorized official
- Name
- Mr. Ryan S. Trettien
- Title
- Executive Director
- Phone
- (912) 532-9308
Corporate family (same tax ID) 2
Practitioners 2
-
Rex O Ajayi, M.D.
-
Theodore Nicholson, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200909002962 | GA | Part B Supplier - Clinic/Group Practice | 9032532205 |
Receives reassigned benefits from 2 practitioners Practice locations: Ocilla, GA |
National Provider Directory
- Tax ID family
- Advent Care Systems of Ocilla LLC
Locations
2116 Ogeechee Rd
Savannah, GA 31415
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | |||
| Clinical Psychologist |
103TC0700X | |||
| Endodontics |
1223E0200X | |||
| General Practice Dentistry |
1223G0001X | |||
| Pediatric Dentistry |
1223P0221X | |||
| Oral and Maxillofacial Surgery (Dentist) |
1223S0112X | |||
| Pharmacist |
183500000X | |||
| Podiatrist |
213E00000X | |||
| Sports Medicine Podiatrist |
213ES0000X | |||
| Foot & Ankle Surgery Podiatrist |
213ES0103X | |||
| Physical Therapist |
225100000X | |||
| Occupational Therapist |
225X00000X | |||
| Multi-Specialty Clinic/Center | 261QM1300X | |||
| Primary Care Clinic/Center | 261QP2300X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
501 N Irwin Ave
Ocilla, GA 31774-5007
Mailing address
PO Box 413
Hinesville, GA 31310-0413
Phone (229) 468-0646
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1139398320 | Other | GA | FQHC - IRWIN COUNTY LOW INCOME CERTIFICATION |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | na | Other |
Other providers in Ocilla, GA
- A & H Drugs LLC
- A & H Drugs LLC
- Lauren W Adams
- Advent Care Systems Home Care of Ocilla, LLC.
- Advent Care Systems of Ocilla, LLC
- Agape for Healing,LLC
- Asf Medical Center Inc
- Asf Medical Center Inc
- Asf Medical Center Inc
- Jacoby Bell
All providers in Ocilla, GA · Rural Health Clinic/Center in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.